The Lady with the Lamp
"When all the medical officers have retired for the night and silence and darkness have settled down upon those miles of prostrate sick, she may be observed alone, with a little lamp in her hand, making her solitary rounds.” This piece of news appeared in a report in The Times during the infamous Crimean War (1853 – 1856) on how Florence Nightingale cared for the wounded soldiers of the war. The iconic representation of Florence Nightingale as the Lady with the Lamp got established as a sign of selfless service of a professional nurse. By defining Nursing as a profession, Nightingale challenged a practice of dumping it as an unskilled work, reserved for the uneducated from the lower strata of society. Owing to her high birth and academic accomplishments, Nightingale’s efforts earned greater attention and approval from the society, which she deftly utilized to redefine Nursing as a noble profession, which requires training in theoretical and practical medical knowledge. Nightingale considered her nursing profession as a greater call towards service of the sick, which became part of the definition of Nursing career, transforming it into an angelic profession. The Lady with the Lamp inspires millions practicing the career of a nurse world over, daring day and night in the professional care of the sick.
BIRTH OF THE LAMP
Florence Nightingale was born on 12 May 1820 into a wealthy and reputed British family in Florence, Italy and she was named after the name of the city of her birth. In 1821, the family came back to England and settled down there. In 1837, Florence experienced an inner inspiration to devote her life “to do something toward lifting the load of suffering from the helpless and miserable.” However, respecting the opposition of her family, she deferred her decision till turned twenty-four. Florence had to fight against the social norms of the Victorian era, which required a woman of her status to become a wife and mother, instead of offering her life for service, not to say the service of a nurse. Against all odds, she trained herself in the art and science of nursing. She also decided to live a life of celibacy to be able to focus on her calling to Nursing.
Nightingale also embarked upon a world tour to study the Nursing practices world over. She worked as an intern in an institute in Kaiserswerth-am-Rhein in Germany for a short while, which inspired her to develop her model for Nursing care. In Athens, Greece Nightingale happened to save a tiny owlet that fell from its nest and protected it from the hands of naughty children. As story goes, Florence named it Athena and made it as her favorite pet, nursing and training it and often tucked it safely in the pocket of her apron, which again became part of her pictures in the years to come. Florence had to forgo this blissful companion, as was called to serve the wounded soldiers of Crimean War in 1854. In Crimea, Nightingale established practices like regular handwashing, good hygiene, proper sanitation and clean habits as part of Nursing care, which is said to have reduced the mortality rates from 42% to just 2%. Reports on Crimea War back in London, praised the success of Nightingale and she became a popular icon of professional Nursing care and earned her the persona of “The Lady with the Lamp”.
Nightingale could repeat a similar feat also in India, where she worked during 1858-1859. Here she focused on improving the quality of water and improving ventilation of military hospitals, which drastically reduced the mortality rates, 60/1000 to 18/1000. Summarizing her findings on professional nursing care, Nightingale published a book, Notes on Nursing (1859), which served as the first textbook on Nursing.
In 1860, Nightingale founded a Nursing School at St Thomas’ Hospital in London, the first secular nursing school of England. Her popularity in the high echelons of the society helped her to raise funds required. Nightingale kept on perfecting her concepts of Nursing based on the evidences accumulated from the praxis. She defined the goal of Nursing as to prepare a safe and caring environment that promotes patient health and wellbeing. Students of nursing were required to imbibe five core Nursing values, namely, human dignity, integrity, autonomy, altruism, and social justice. She emphasized on compassionate and committed patient care and diligent and professional hospital administration. Nightingale thus became the Mother of Modern Nursing.
The Crimean fever or Brucellosis, which Nightingale contracted during her Nursing days in Crimea began to pop up during these years with prolonged symptoms. The burden of tasks and works also pushed her into chronic depression. From early 1880s, Nightingale was practically bedridden and continued to work from her sick-bed for 38 long years till her death. Nightingale pioneered her works in the field of hospital planning and management, laying foundation to the discipline of hospital administration. Eventually, her intellectual outputs waned along with it also her eyesight. She died peacefully in her sleep on 13 August 1910, at the age of 90.
Nightingale was an iconoclast, who excelled the societal expectations on a noble lady as she was. She decided to develop and dedicate her skills to make a difference in the world. She embraced a career, which was looked down upon and ennobled it with her contributions. She was prepared to make many sacrifices for her option to serve the sick; she had to forgo her married life; she put her physical and mental health as ransom to her career. She equipped herself for the chosen career, with every talent given to her. She studied mathematics and statistics and was an expert in both, which helped her challenge assumptions and draw rational conclusions.
Cassandra, a fict ionalized autobiographical novel Nightingale wrote, describes her disgust against the lethargic lifestyle of women in the Victorian era, despite their education and make a ferocious attack on the most sacred of Victorian institutions: the family. In mythical literature, Cassandra was a princess of Troy who served as a priestess in the temple of Apollo during the Trojan War. Apollo gave her the gift of prophecy; but when she refused his advances, he cursed her so that her prophetic warnings would go unheeded. Years after this curse, Cassandra was killed by a woman. Taking cue from this mythical story, Nightingale laments the tragedy of noble ladies of the time, which she could only narrowly avoid against great resistance from her family circles. “Rather, ten times, die in the surf, heralding the way to a new world, than stand idly on the shore,” she admonished. Nightingale, who broke many paradigms associated with the female gender in establishing nursing as a worthy profession, champions the cause of creative outbursts, who overcame the fear of it.
Nightingale followed an evidence-based approach in developing principles and praxis of Nursing. She pooled rich practical experiences from her services in Crimea and India and established statistics as a tool of analysis and communication of ascertained conclusions. Nightingale is considered one of the pioneers of graphical or visual presentation of data. “To understand God’s thoughts, we must study Statistics, for these are the measure of his purpose,” Nightingale was convinced.
She not only used methods like pie chart, but also developed a form of the pie chart known as Nightingale’s Rose Diagram, equivalent to modern circular histogram. Her contributions towards medical Statistics was recognized through her election to the membership of the Statistical Society of England. Visual representations of data helped policy makers to comprehend the causal connections and correlations among data better and to accelerate the process of decision making. Nightingale can be considered as the pioneer of modern infographics.
Nightingale was prodigious and lifelong learner. As a child, she was blessed with the opportunity to learn Latin and classical Greek. Soon she also mastered English, French, German, and Italian, opening new horizons of different intellectual cultures. Her multilingual abilities also her global trips, not knowing the barriers of language. Apart from Mathematics and Statistics, Florence was also introduced to Philosophy and Shakespearean literature in her childhood itself.
Nightingale was equipped to learn from different sources across the globe and to harmoniously organize the learnings into an organic whole. She modelled her healthcare and nursing system after the Kaiserswerth-am-Rhein Institute in Germany. She adopted the administrative methods for her hospital from Sisters of Charity of France. This world-openness and ability to learn from evidences helped her develop methods to control infectious diseases and avoid hospital infections, even before antibiotics were discovered by Louis Pastor in 1877! Her insistence on her nurses to wash her hands very frequently during their work, was based on her observations, rather than from the full knowledge of transmission of diseases.She also insisted on the strengthening of human immune system through healthy diets to reduce the vulnerability to infectious diseases, as it was emphasized in eastern medical systems. In other words, proportional to the learn-ability of Nightingale, the rivers of knowledge from all directions of the world have flown towards her, ratifying her theories and praxes.